I am a plastic surgeon in Little Rock, AR. I used to "suture for a living", I continue "to live to sew". These days most of my sewing is piecing quilts. I love the patterns and interplay of the fabric color. I would like to explore writing about medical/surgical topics as well as sewing/quilting topics. I will do my best to make sure both are represented accurately as I share with both colleagues and the general public.

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Thursday, May 28, 2009

My mother died last Tuesday. She had her coronary bypass surgery just one week before that day. It was during her CABG that she had her strokes. Yes, strokes, plural. She was one of those 1.5% who suffer macroemboli cerebral strokes during coronary bypass surgery.

I went looking for information on it earlier this week. I went through my training without ever seeing this complication. Like everyone, I never thought my family would be the one. I think it is better to go to surgery, NOT thinking you will be the “statistic” as far as complications go. Anyone having surgery, SHOULD go into it feeling hopeful and thinking everything will go perfectly.

The article referenced below is a good review of this complication – stroke during coronary bypass surgery. The study is a retrospective review of 6682consecutive coronary bypass patients who only had the CABG procedure and not other simultaneousprocedures, such as carotid endarterectomy.

They list the possible sources of the emboli as the ascending aorta, carotid arteries, intracerebralarteries, or intracardiac cavities. They state that they believe the most likelysource is the ascending aorta, for the following reasons:

First, the ascending aorta is the site of surgical manipulationsduring CABG, whereas mechanical contact is not made with theother potential sources of emboli. Embolization of atheroscleroticdebris is most likely to occur during aortic cannulation/decannulation,cross-clamp application/removal, and construction of proximalanastomoses. However, embolization of atherosclerotic debrismay also occur when the aorta is not being surgically manipulated,due to the ‘sandblast’ effect of CPB.

Third, our chart review suggested that the most common probablecause of stroke was atherosclerotic emboli from the ascendingaorta. Palpable lesions in the ascending aorta were noted ina large proportion of stroke patients.

The fourth reason we believe the ascending aorta is the likelysource of macroemboli is because of ancillary autopsy data.…….

Note the second reason given above – the independent predictors of stroke. My mother was over 74 yr so fell into the elderly age risk factor group. She was also a type 2 diabetic. She was noted to have a small abdominal aneurysm and some renal artery stenosis on the angiogram (an accidental pickup). So she had three of the four independent risk factors.

3 comments:

Hello I am so sorry for your loss, I have just come from the hospital where I have been told that my Grandmother was also in the 1.5% and suffered a massive stroke during her bypass surgery. She is still breathing and her heart is beating but she is not there, she is not 'alive'. Like your mother, at 77 she was also in the elderly bracket but not for one moment did we believe this could happen. God bless I hope we can both overcome our grief.

Thank you for posting this. I've been searching for answers, as it appears my father has suffered a stroke (or plural) during bypass surgery. He was supposed to have awakened yesterday, but is not responding to verbal or physical stimuli. We are terribly concerned, of course, and don't know what the next days will hold.

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